It takes heart: Cardiovascular approaches to combat hypertensive disorders of pregnancy

During pregnancy, women are bombarded with challenges that they did not sign up for — morning sickness, hot flashes, constipation, even gestational diabetes. Particularly terrifying is the risk of developing high blood pressure-related disorders such as preeclampsia, eclampsia, and gestational hypertension, known together as hypertensive disorders of pregnancy (HDP). A 2024 preliminary study by researchers at Tufts University found an association between a healthy cardiovascular system and decreased prevalence of HDPs, even for those with genetic predisposition to these disorders. If replicable, these findings could help millions of women take charge of their heart health during pregnancy. 

The CDC estimates that anywhere from 13-16% of women in the United States endure an HDP, with significantly higher rates among those of advanced maternal age, Black women, American Indian women, those from rural areas, and those with higher genetic predisposition. At best, these disorders can mimic regular pregnancy symptoms — headaches, trouble breathing, and stomach pain. At worst, they can lead to seizures and death. Clinical guidelines from the American College of Obstetricians and Gynecologists recommend frequent blood pressure monitoring and administration of aspirin, but focus little on lifestyle changes that women can implement to prevent HDPs or attenuate their severity. 

That’s why this new study is especially exciting. The researchers assessed the first-trimester cardiovascular health and genetic risk (polygenic score) of over 5,000 young mothers to understand the impact of both factors on HDPs. Cardiovascular health was evaluated using the American Heart Association’s Life’s Essential 8, which includes factors like diet, physical activity, and weight management. The study found that women with the highest cardiovascular health scores had a 35 to 62% lower risk of developing hypertensive disorders, regardless of their genetic risk. Key contributors to these disorders included higher body mass index and poor diet. 

“During pregnancy, women are bombarded with challenges that they did not sign up for.”

However, this study has its limitations. Most glaringly, this is a retrospective study that used a cohort of young mothers who had delivered for the first time. Although the women were from a variety of regions, races, and ethnicities, they were undoubtedly on the younger side. More research is needed to determine whether similar outcomes are possible for older mothers-to-be. Even more, no conclusions about the true impact of cardiovascular health on HDPs can be drawn, as this is not a randomized, controlled trial. However, this data is compelling because it shows that even women who were predisposed to HDPs had avoided them through heart-healthy habits. 

Then comes the question on every good clinical researcher’s mind: can this be translated into practice? After all, isn’t being pregnant hard enough, without having to manage your weight, police your diet, and get your steps in? Yes, but research on self efficacy during pregnancy shows that many women are willing to put in the work. As one 2015 study by a Swedish research team found, the belief of mothers-to-be in their ability to control their health is a “positive dimension that interplays with other aspects and contributes to well-being during pregnancy.” 
Pregnant women may finally be able to control HDPs through lifestyle modifications. There is already a wealth of research on how to achieve heart health via blood pressure reduction. For example, the Dietary Approaches to Stop Hypertension (DASH) diet emphasizes low sodium, and high intake of fruits, vegetables, whole grains and lean proteins. On the other hand, depending on the quality of local grocery stores, familial support, neighborhood safety, and a number of other factors, it may be infinitely more difficult for some women to manage their heart health through diet and physical activity. But when a pregnant woman, her support system, and her doctor put their heads together to develop an individualized lifestyle plan, they can beat the odds.